title: Thromboembolism and venous thrombosis of the deep veins in surgical children--an increasing challenge?
abstract: Children share many known predisposing risk factors for venous thromboembolism and deep venous thrombosis but appears less common and is probably underestimated. Fatal pulmonary embolism is rare but may also be missed because of low level of clinical awareness. The aim of this study was to investigate children with thromboembolism of deep veins to evaluate risk factors and highlight their danger.
  
  
  METHODS
  This was a retrospective review of all children (<13 years old) diagnosed with a venous thromboembolism (1993-2009). Clinical and radiologic features and any risk factors were documented. Venous thromboembolism was diagnosed on clinical suspicion together with compressive Doppler studies, spiral computed tomography, or magnetic resonance scan.
  
  
  RESULTS
  Eighteen children with a consistent clinical picture were identified (painful unilateral limb swelling). Their mean age was 9.3 years with a male/female ratio of 3.5:1. Predisposing factors were identified in 17 (95%). These included infective conditions (n = 11), previous femoral line (n = 3), trauma (n = 2), and complicated appendicitis (n = 2). Chronic infective and inflammatory conditions included tuberculosis (n = 4), HIV (n = 3), staphylococcal septicemia (n = 2), and Takayasu arteritis (n = 1). Pulmonary embolism occurred in 5 (28%), and 1 presented later with a post-phlebitic leg. Elevated factor VIII was seen in 3.
  
  
  CONCLUSIONS
  This study identified an association with known risk factors in most children with venous thromboembolism and suggests that those with femoral venous access or ongoing chronic infective states (eg, TB/HIV) are particularly at risk.
authors.affiliation: Division of Paediatric Surgery, Faculty of Medicine, University of Stellenbosch, Tygerberg, South Africa.
authors.forename: Nyawaleni
authors.initials: N
authors.lastname: Tshifularo
authors.forename: Marion
authors.initials: M
authors.lastname: Arnold
authors.forename: Samuel W
authors.initials: SW
authors.lastname: Moore
mesh_terms: D001064:Appendicitis / Q000453:epidemiology; D055499:Catheter-Related Infections / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003906:Developing Countries; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008297:Male; D011300:Preoperative Care; D015995:Prevalence; D011655:Pulmonary Embolism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D013625:Takayasu Arteritis / Q000453:epidemiology; D013923:Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D013924:Thrombophlebitis / Q000453:epidemiology; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000453:epidemiology